Thursday, March 13, 2014

Lemon Treatments






Lemon” -  Any product with flaws too great or severe to serve its intended purpose. Often used to refer to cars that seem perfectly fine on the exterior, but quickly break down once you start driving them.

I mentioned in my last QOTD a great podcast series created by JJ Carolan. One of my fave episodes from her podcast is called "Identifying Fad Science". It’s all about the responsibility of BCBAs to help teach families/caregivers how to test unproven therapies, and how to be a critical consumer.
(I will mainly refer to BCBA’s in this post, but all ABA professionals have a responsibility to help our clients distinguish between true science and junk science. More than an ethical requirement, I believe we are morally bound to do this).

I have learned the hard and awkward way, that no matter how nicely & professionally you explain to a family that you are NOT a doctor and are not qualified to answer questions outside your expertise, you may still get very difficult, emotion packed questions tossed your way.

I don’t meet many families who are only doing ABA therapy. Some of the other treatment choices families choose are supported by research, and some are not. As a Behavior Analyst, it is your responsibility to have knowledge of available treatments and which ones are effective. If you come across a treatment you are unfamiliar with, it is your responsibility to conduct a literature review and gather information. BCBAs cannot administer or promote interventions that are not empirically supported.
 If you’re not a BCBA and think this topic doesn’t apply to you, then think again. Even if ABA is a part time job to you, you’re signing up to provide treatment to an individual who needs help. Would you want your dentist sprinkling fairy dust on your broken tooth? Would you want your doctor to tell you to jump 2 times to fix a broken arm? Well, your clients also expect to receive effective treatment.

So if you can’t endorse or support unproven treatments, then what can you do when these issues arise?

1) Always defer to expert opinion, such as a Doctor or an Occupational Therapist. Clearly state your qualifications and training, and explain why you are not the appropriate person to ask. Be firm and clear, without being rude or judgmental. Please don’t be allergic to saying “I don’t know”. Say to the parent “I haven’t heard of that, but I can look into it for you and bring back some information that we can review”.

2) Give the family the tools to be a critical consumer. Help your clients learn to collect and track data, in order to measure the effectiveness of treatments. I understand why most families do not want to dig through research journals. Research isn’t always exciting, but it does save wasted time spent pursuing lemon treatments.  

Below are characteristics of Pseudo science, aka Junk Science, aka “Lemon Treatments”. These should be in your mental arsenal, ready at a moments notice to help explain to a family why you cannot endorse or support the treatment they are so excited about. Lemon treatments may not just waste money or time, they could also be potentially harmful or dangerous.

5 Characteristics of Pseudo Science

1. Promise of lightning fast results- Overnight or rapid changes are promised, along with just a few easy steps to follow.

2. Requires little experience to administer- Just reading a pamphlet or attending a seminar is enough to learn how to administer the treatment. Also, beware of treatments lacking sufficient supervision or oversight by a qualified professional.

3. Emotionally appealing slogans- “Choosy moms choose Jif”…so I guess moms who choose Skippy should be jailed?? Beware of emotional words like “cure”, “miracle”, or “life –saving”, these treatments are trying to pull on the heart strings.

4. Lack of peer reviewed evidence – Where is the data? Is there any? How is progress measured? Has the treatment been replicated in various studies?

5. Exact procedure is vague or secretive- Not too long ago, a parent asked me my opinion about a new treatment they were pursuing. I hadn’t heard of the treatment, so I started asking questions about how it worked, what was it supposed to do, etc. The parent could not answer my questions, and commented that I was asking too many. My response was “Well, if I were paying for this expecting it to help my child I would want to know exactly how it works”. Beware of treatments where you have to pay a membership fee, attend a lecture, or buy the product before anyone will explain it in depth.


*Resources: 

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